Provider Demographics
NPI:1922059625
Name:PENSABENI JASPER, TIZIANA (MD)
Entity Type:Individual
Prefix:
First Name:TIZIANA
Middle Name:
Last Name:PENSABENI JASPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 CLIFTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3642
Mailing Address - Country:US
Mailing Address - Phone:973-778-4440
Mailing Address - Fax:973-778-4427
Practice Address - Street 1:1135 CLIFTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3642
Practice Address - Country:US
Practice Address - Phone:973-778-4440
Practice Address - Fax:973-778-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA063681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1922059625OtherINDIVIDUAL NPI
NJ885565VG1Medicare PIN